Diseases such as diabetes, heart disease, cancer and arthritis are associated with a high burden of disease and account for a high financial burden in Australia. The burden of disease and injury is a measurement of the time lost due to premature death along with years of healthy life lost due to disability. Cancer and cardiovascular disease accounted for 37% of the total burden of disease and injury in Australia in 2003, mortality from these diseases accounting for 80% of that burden. Mental disorders and neurological and sense disorders were the next leading causes of the burden of disease and injury, together accounting for a further 25% of the total burden. However, mortality from these disorders contributed little.

Many chronic diseases can be prevented or delayed by addressing lifestyle factors such as poor diet or insufficient exercise, or by better management of conditions such as high blood pressure or obesity. There are a range of initiatives in place to prevent and manage chronic disease and reduce its impact.

Table 11.12 shows health expenditure on seven major disease groups. In total, expenditure in these areas in 2004-05 accounted for $25.5 billion (b), equivalent to 48% of allocated health expenditure for the year.

11.12 HEALTH EXPENDITURE BY DISEASE GROUP, 2004-05 ($million)

Selected disease groups

Hospital(a)

Pharmaceuticals(b)(c)

Community and public health(d)

Research

Total

Cardiovascular disease

4 142

1 636

-

164

5 942

Arthritis and other musculoskeletal disease

3 184

680

-

92

3 956

Injuries

3 267

124

-

14

3 405

Mental disorders

1 949

854

1 177

148

4 128

Cancer

2 951

236

222

378

3 787

Diabetes mellitus

659

275

-

55

989

Respiratory disease

2 516

725

-

69

3 310

Total selected disease groups

18 668

4 530

1 399

920

25 517

Total allocated health expenditure

36 121

8 144

1 399

1 715

52 660

- nil or rounded to zero (including null cells)

(a) Includes public and private acute and psychiatric hospitals. Also includes medical services provided to private admitted patients in hospital.

(b) Includes all pharmacueticals for which a prescription is needed, inluding benefit paid, private and under copayment prescriptions.

(c) Excludes over the counter medicaments such as vitamins, minerals, patent medicines, first aid and wound care products, analgesics, feminine hygiene products, coldsore preparations and a number of complementary health products that are sold in both pharmacies and other retail outlets.

Cardiovascular disease encompasses all diseases and conditions involving the heart and blood vessels including high blood pressure, heart disease, stroke and peripheral vascular diseases. While ischaemic heart disease has been the leading cause of death in Australia over the past 10 years, the number of deaths due to this cause has decreased, from 28,299 in 1998 to 22,729 in 2007.

In 2004-05, the highest health expenditure of all disease groups was for cardiovascular disease, accounting for 11.3% of total allocated health spending.

The 2007-08 NHS indicated that around 3.4 million Australians (16%) reported having a cardiovascular disease as a long-term condition (having lasted or being expected to last for six months or more). The most common cardiovascular disease reported was hypertension (high blood pressure) reported by 9% of the population. In the 45-54 age group, 10% reported having hypertension. Of those aged 75 years and over, the proportion increased to 39%.

Cardiovascular disease was mostly experienced by people in middle and older age groups. Almost one in five (19%) of those aged 45-54 years had a current long-term cardiovascular disease, rising progressively to 62% of those aged 75 years and over.

Mortality

Despite declines in mortality rates in the last 30 years, cardiovascular disease remains one of the leading causes of death in Australia in 2007, accounting for 46,626 or 34% of all deaths. Ischaemic heart disease accounted for 17% of all deaths, and cerebrovascular diseases a further 8%.

The standardised death rate for cardiovascular disease was 197 per 100,000 population in 2007, a decrease from 201 per 100,000 population in 2006 and 300 per 100,000 population in 1998 (graph 11.13). The standardised death rate for males in 2007 was 236 per 100,000 and 164 per 100,000 for females.

11.13 DEATH RATES FOR CARDIOVASCULAR DISEASE(a) 1997-2007

Arthritis and other musculoskeletal diseases

Osteoarthritis, rheumatoid arthritis and osteoporosis are the most commonly occurring musculoskeletal conditions. Although they are not immediately life threatening and have low associated mortality, they have substantial influence on the quality of life and impose a heavy economic burden on the community.

In 2004-05, total health expenditure attributable to musculoskeletal diseases was $4.0b, which accounted for 7.5% of allocated health system expenditure (table 11.12).

Osteoarthritis is one of the most common types of arthritis and affects the cartilage in the joints. Cartilage cushions the ends of bones where bones meet to form a joint. In osteoarthritis this cartilage degenerates. Osteoarthritis is most commonly found in the knees, neck, lower back, hip and fingers.

Rheumatoid arthritis is the most common form of inflammatory arthritis. Inflammatory arthritis is characterised by joint swelling and destruction. In rheumatoid arthritis the immune system attacks the tissues lining the joints. As a result of this attack, inflammation occurs causing pain, heat and swelling. The disease can also cause inflammation of connective tissue, blood vessels and organs.

Osteoporosis (porous bones) is a disease where bone density and structural quality deteriorate, leading to an increased risk of fracture. The most common sites of fracture are the bones of the spine, the hip and the wrist. However other bones are commonly affected, including the shoulder, ribs and the pelvis.

The 2007-08 NHS shows 15% of people reported that they currently had arthritis; 13% of males and 17% of females. Of those with arthritis, 51% had osteoarthritis and 14% rheumatoid arthritis. The proportion of people with arthritis increased with age from less than 1% of people less than 25 years to 48% of people aged 65 years and over (graph 11.14).

Overall, 3% of people had osteoporosis: 1% of males and 5% of females.The proportion of people with osteoporosis increased, from less than 1% of people aged less than 45 to 11% of people aged 65-74, then decreased to 9% in people aged over 75.

11.14 PREVALENCE OF ARTHRITIS AND OSTEOPOROSIS 2007-08

Injuries and deaths due to external causes

Injury and poisoning are broad terms that encompass the adverse effects on the human body that may result from events. These events may be accidental, such as falls, vehicle accidents and exposure to chemicals, or intentional such as suicide attempts and assaults by other people. Such events, and the factors involved in them, are collectively known as 'external causes of injury and poisoning', and are a significant source of preventable illness, disability and premature death in Australia.

Males and females, and people in different age groups, experience different levels and types of risk from injury events (risk in this sense refers to both the probability of an injury event occurring and the severity of the injuries that may result). High risk drinking, drug use and hospitalisation due to transport accidents and assault are all more prevalent among the 15-24 age groups. Young people, especially young men, are at a greater risk than other age groups of experiencing injury and death due to the above behaviours.

Morbidity

The 2007-08 National Health Survey found that nearly 2.5 million people (12%) had a condition that was caused by injury. The most common conditions that were caused by an injury were back problems, affecting 8.2% of people, and partial deafness or hearing loss, affecting 1.0% of people.

Injuries that resulted in long-term conditions most commonly occurred at work (42%), as a result of exercise or sport (20%), in a motor vehicle accident (17%), or in the home (12%) (graph 11.15).

In 2007, external causes were responsible for 7,893 deaths, or 5.7% of all registered deaths. The standardised death rate for external causes was 36.1 per 100,000 people in 2007, a decrease from 36.7 in 2006, and 44.6 in 1998.

Males are more likely to die from external causes than females, and at a younger age. In 2007, consistent with previous years, nearly two-thirds (65%) of deaths resulting from external causes were males. Median age at death for deaths from external causes was 45.5 years for males and 66.6 years for females.

There were 1,880 deaths attributed to intentional self-harm (suicide) in 2007, accounting for 24% of deaths from external causes. Transport accidents accounted for 1,340 deaths, or 17% of total deaths from external causes.

Cancer

Cancer is a disease of the body's cells. Normally, cells grow and reproduce in an orderly manner, however, sometimes, abnormal cells will grow. These abnormal cells may then reproduce and spread uncontrolled throughout the body. Cancer is the term used to describe about 100 different diseases including malignant tumours, leukaemia (a disorder of the white blood cells), sarcoma of the bones, Hodgkin's disease and non-Hodgkin's lymphoma (affecting the lymph nodes) in which uncontrolled cell growth threatens the rest of the body. Malignant neoplasms (cancer) are a major cause of death in Australia and accounted for 7.2% of allocated health system expenditure in 2004-05 (table 11.12).

Morbidity

It should be noted that the 2007-08 National Health Survey excluded people in hospitals, nursing and convalescent homes and hospices. This is expected to have a greater effect on data for cancer than for most other conditions.

In the 2007-08 NHS, an estimated 326,600 Australians (1.6%) reported they currently had a medically diagnosed malignant neoplasm.

According to the AIHW and the Australasian Association of Cancer Registries there were 100,514 new cancer cases registered in 2005. During the 1998-2004 period, the five-year relative survival proportions calculated for all cancers for females were 64% (53% in 1982-1986), higher than those for males - 58% (41% in 1982-86). All cancer 5 year relative survival rates increased for diagnoses made during the 1998-2004 period, compared to earlier data, which may be a result of earlier detection and treatment advances.

Of all cancers in 2005, prostate cancer was the most commonly occurring followed by colon and rectal. The next most common cancers were breast, followed by skin melanoma and lung cancer (table 11.16). Cancer occurred more commonly in males than females and was most prevalent in people aged 65 years and over (6%) but just over two-thirds (66%) of those with skin cancer were aged less than 65 years.

11.16 DEATHS, INCIDENCE AND SURVIVAL RATES FOR COMMON REGISTERABLE CANCERS

DEATHS (2007)

INCIDENCE (2005)

FIVE YEAR SURVIVAL(a)

Males

Females

Males

Females

Males

Females

Cancer site

no.

no.

no.

no.

%

%

Stomach

704

425

1 228

676

24.4

25.3

Colon

1 295

1 244

4 400

4 184

60.9

61.6

Rectum(b)

474

293

2 222

1 247

61.9

64.5

Pancreas

1 233

1 015

1 119

1 062

4.5

4.7

Lung(c)

4 713

2 910

5 738

3 444

10.7

14.0

Skin (melanoma)

864

415

6 044

4 640

89.7

94.1

Breast

26

2 680

95

12 170

82.0

87.8

Uterus

-

338

-

1 830

-

82.1

Cervix

-

208

-

734

-

71.8

Ovary

-

848

-

1 205

-

39.8

Prostate

2 938

-

16 349

0

85.3

-

Testis

26

-

677

0

96.8

-

Bladder

630

295

1 707

555

62.3

54.8

Kidney

539

316

1 528

769

65.6

66.0

Brain

666

457

812

610

18.5

19.4

Thyroid

41

64

396

1 216

87.7

95.3

Unknown primary

1 318

1 211

1 658

1 568

10.6

7.6

Hodgkin's Disease

43

27

279

248

84.8

85.8

Non-Hodgkin's Lymphoma

733

586

2 094

1 809

61.6

62.6

Leukemia

892

577

1 568

1 023

48.2

47.3

All cancers

22 774

17 513

56 158

44 356

58.4

64.1

- nil or rounded to zero (including null cells)

(a) Cohort of records diagnosed in 1998-2004.

(b) Excluding anus and anal canal.

(c) Including trachea and bronchus.

Source: ABS data available on request, 2007 Causes of Death; Australian Institute of Health and Welfare, Cancer survival and prevalence in Australia: cancers diagnosed from 1992 to 2004, CAN 38.

Mortality

In 2007 cancer accounted for 40,287 deaths or 29% of all deaths registered. Of these, there were 22,774 male deaths and 17,513 female deaths (table 11.16).

More males than females died of cancer with 130 male deaths per 100 female deaths for the 2007 registration year. The median age of people dying from cancer in 2007 was 74.7 years for males, 75.3 years for females and 74.9 years for all cancer deaths. Potential life lost due to cancer deaths was 186,439 years for males and 148,808 years for females.

Mortality is influenced by the number of new cases of cancer (incidence) and the length of time lived after the initial diagnosis of cancer is made (survival). Relative survival is a measure that takes into consideration the crude survival (time between diagnosis and death) in the cancer population, and the corresponding expected survival in the general population.

Diabetes mellitus is a long-term condition characterised by high blood glucose level, which results from either the body producing little or no insulin, or the body not using the insulin properly (insulin resistance). Insulin is a hormone produced by the pancreas that helps the body cells use glucose.

There are three major types of diabetes mellitus. Type 1 diabetes is marked by extremely low levels of insulin. Type 2 diabetes is marked by reduced levels of insulin, or the inability of the body to use insulin properly. Gestational diabetes (which occurs in about 5% of pregnancies of women who have not been previously diagnosed with diabetes) is not usually long-term. However, for women diagnosed with gestational diabetes, there is an increased risk of developing Type 2 diabetes later in life.

Diabetes is a costly disease, associated with substantial morbidity and mortality, primarily from cardiovascular complications, eye and kidney diseases, and limb amputations. In 2004-05, total health expenditure attributable to diabetes was nearly $1.0b, accounting for 1.9% of allocated recurrent health system expenditure (table 11.12).

Morbidity

Results from the 2007-08 NHS indicate that 818,200 Australians or around 4% reported having diabetes as a long-term condition. Results from the three successive surveys show diabetes is a growing health problem in Australia. The prevalence of diabetes has risen from 3.0% in 2001, to 3.5% in 2004-05 and 4.0% in 2007-08.

Mortality

In 2007, diabetes mellitus was the underlying cause of death in 3,810 deaths, 2.8% of all deaths registered. Of these, 1,923 deaths were males and 1,887 females. The highest number of deaths resulting from diabetes over the past ten years was recorded in 2007, with the proportion of all deaths represented by this cause increasing from 2.3% in 1998 to 2.8% in 2007.

In addition to deaths where diabetes was the underlying cause, there were a further 9,291 deaths in 2007 where diabetes was listed as an associated (or contributing) cause of death. Where diabetes was recorded as the underlying cause of death, other conditions listed as associated causes included ischaemic heart disease (51%) and hypertensive diseases (32%).

Asthma

Asthma is a chronic inflammatory disorder of the lung's air passages which makes them narrow in response to various triggers. This leads to episodes of shortness of breath and wheezing. Asthma can begin at all ages, including the very young. The disease can start as a mild chronic cough and lead to mild or severe wheezing, and sometimes even to respiratory arrest.

Although asthma has low associated mortality, people with asthma can experience reduced quality of life and require a range of health services, from general practitioner care to emergency department visits or hospital in-patient care. It is one of the most frequent reasons for hospitalisation among children aged 0-9 years.

The management of asthma is an important public health issue because of the personal burden it places on those with asthma, often with onset in childhood, and the financial burden it places on the health system. Of respondents with long-term asthma in 2007-08, 22% had a day away from work, school or study and 9% visited a hospital or emergency department in the 12 months prior to interview.

The prevalence of asthma in Australia is one of the highest in the world, with more than two million Australians (10%) reporting the disease in 2007-08. Asthma is more prevalent in young people than older age groups. For people under 25 years of age, the prevalence of asthma was 11%. Up to 14 years of age, asthma was more common among males, however asthma was more prevalent among females in all age groups 15 years and over.

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